Utah study: Unnecessary Pap tests still common

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Millions of American women, including those who have had hysterectomies, continue to be unnecessarily screened for cervical cancer, says a University of Utah researcher.

It's a decadelong problem that hasn't improved much, despite clear and consistent guidelines against "Pap" tests for these women, said Deanna Kepka, a Huntsman Cancer Institute (HCI) investigator and assistant professor in the U.'s nursing department.

Kepka reviewed data from the 2010 National Health Interview Survey, a door-to-door poll conducted by the U.S. Centers for Disease Control and Prevention (CDC).

Almost two-thirds, or 65 percent, of women who have had hysterectomies reported having recent Pap tests, she found. And half the women over 65 who have no cervical cancer history also reported a recent test.

That's 14 million women being subjected to an unnecessary procedure, costs and risks, said Kepka.

It's a question of resources, she said. "Shouldn't we be focusing our attention on other more pressing issues like obesity and healthy diet and exercise and getting screenings that you should be getting, such as mammograms?"

Kepka co-wrote the study on a postdoctoral fellowship funded by the National Cancer Institute. The findings were published Monday in the Journal of the American Medical Association Internal Medicine.

They are based on self-reporting and subject to bias. But they mirror several other studies, including, most recently, a 2010 CDC report charting a decade of over-testing.

"We knew there would be overuse of Pap tests," said Kepka. "But we were shocked to see so little change over the past 10 years."

Women who have had hysterectomies do not benefit from the cancer screening because nearly all of them no longer have a cervix. Only 2.4 percent of hysterectomy patients in 2005 had cervix-sparing surgeries, which have been shown to be of no clinical benefit, said Kepka.

Pap tests, named for inventor George Papanicolaou, are also of no benefit to most women over age 65  those for whom regular screenings have shown no cancer or pre-cancerous conditions.

Guidelines from major doctor groups and the U.S. Preventive Services Task Force have discouraged testing for these groups since 2003.

But "habits are tough to change," said Kepka, noting Pap tests are an annual rite for women, traditionally the primary reason for annual gynecological exams.

Evolving guidelines can be confusing, which is why it's important for patients to confer with their doctor and for doctors to take complete medical histories, she noted. "If a woman is 70 and has only had one Pap test in her life, she might need a Pap test."

Kepka is working on another study calculating the costs of superfluous Pap tests, which patients are increasingly required to shoulder.

She's also exploring the demographics of women likely to receive unnecessary tests and how it breaks down in Utah.

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